Type 2 diabetes, a form of diabetes mellitus, is likely one of the better-known chronic diseases in the world — and it makes sense that this would be the case. Data from the Centers for Disease Control and Prevention (CDC) suggests in the United States alone, 30.3 million people, or 9.4 percent of the U.S. population, have diabetes, and the majority of these people have type 2. (1)

Among those individuals with diabetes, 7.2 million don't even know they have it, and an increasing number of young people are being diagnosed with prediabetes and type 2 diabetes. (1) A study published in May 2018 in the journal Diabetologia revealed that an earlier diabetes diagnosis may increase the risk for health complications, including heart disease and certain types of cancer. (2)

Whether you've been diagnosed with type 2 diabetes or have a family history of the disease, this condition and the risk for health complications that may come with it can be scary. And with the required diet and lifestyle changes, there's no question that this diagnosis can be a challenging one to reckon with.

But living with type 2 diabetes doesn’t have to be devastating. In fact, when you're educated about the disease — such as understanding how insulin resistance develops and how to mitigate it, knowing how to spot the signs of diabetes, and learning what to eat — you can tap into the resources you need to lead a happy, healthy life.

Indeed, research published in December 2017 in the journal BMJ suggested you may even be able to put type 2 diabetes in remission by making adjustments to your diet and lifestyle. (3) Among the exciting advancements are the use of the high-fat, low-carb ketogenic diet as a therapeutic approach to manage type 2 diabetes, noted a review published in September 2018 in Expert Review of Endocrinology & Metabolism. (4)

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Signs and Symptoms of Type 2 Diabetes

During the early stages of the disease, type 2 diabetes often doesn’t present any symptoms at all, according to previous research. (5) Still, you should be aware of the symptoms and early warning signs, such as the following, per the Mayo Clinic: (6)

Causes and Risk Factors of Type 2 Diabetes

Researchers don't know what causes type 2 diabetes, but they believe several factors are at play. Those factors include genetics and lifestyle, according to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). (7)

At the root of type 2 diabetes is insulin resistance, and prior to a type 2 diabetes diagnosis, you may be diagnosed with prediabetes, notes the NIDDK. (8)

Insulin Resistance

Type 2 diabetes is marked by high blood sugar that your body can’t bring down on its own, according to the NIDDK. High blood sugar is called hyperglycemia; hypoglycemia is low blood sugar. (8)

Insulin — the hormone that allows your body to regulate sugar in the blood — is made in your pancreas. Essentially, insulin resistance is a state in which the body’s cells do not use insulin efficiently. As a result, it takes more insulin than normal to transport blood sugar (glucose) into cells, to be used immediately for fuel or stored for later use. A drop in efficiency in getting glucose to cells creates a problem for cell function; glucose is normally the body’s quickest and most readily available source of energy, notes the NIDDK. (8)

Insulin resistance, the agency points out, doesn’t develop immediately, and often, people with the condition don’t show symptoms — which may make getting a diagnosis tougher. (8)

More on Type 2 Diabetes Causes

As the body becomes more and more insulin resistant, the pancreas responds by releasing an increasing amount of insulin. This higher-than-normal level of insulin in the bloodstream is called hyperinsulinemia, per the NIDDK. (8)

Prediabetes

Insulin resistance sends your pancreas into overdrive, and while it may be able to keep up with the body’s increased demand for insulin for a while, there is a limit to insulin production capacity and eventually your blood sugars will elevate — leading to prediabetes, the precursor of type 2 diabetes, or type 2 diabetes itself, according to the NIDDK. (8)

Prediabetes and type 2 diabetes are some of the most prevalent diseases in the world — altogether affecting 100 million Americans, according to the CDC. Nontheless, according to an article published in June 2016 in Current Cardiology Reports, researchers still aren’t completely sure which genes cause insulin resistance. (8,9)

Obesity Being obese or overweight puts you at significant risk for developing type 2 diabetes. Body mass index (BMI) determines whether you are obese or overweight, according to the National Heart, Lung, and Blood Institute (NHLBI). (10)

Poor Eating Habits The American Diabetes Association (ADA) emphasizes that eating too much of the wrong kinds of foods can increase your risk of type 2 diabetes. (11) Studies have shown that eating a diet high in calorie-dense, processed foods and beverages, and low in whole, nutrient-rich foods, can significantly increase your risk of type 2 diabetes. Foods and drinks to limit include white bread, chips, cookies, cake, soda, and fruit juice. Foods and drinks to prioritize include fruits, veggies, whole grains, water, and tea.

Too Much TV Time The Harvard T.H. Chan School of Public Health notes that watching too much TV (and sitting too much in general) may increase your risk for obesity, type 2 diabetes, and other ailments. (12)

Not Getting Enough Exercise According to John Muir Health, just as body fat interacts with insulin and other hormones to affect diabetes development, so does muscle. (13) Lean muscle mass, which can be increased through cardiovascular exercise and strength training, plays a role in protecting the body against insulin resistance and type 2 diabetes.

More on Type 2 Diabetes Risk Factors

Sleep Habits Sleep disturbances can affect the body’s balance of insulin and blood sugar by increasing the demand on the pancreas, the National Sleep Foundation points out. (14) Over time, this can lead to type 2 diabetes.

Polycystic Ovarian Syndrome (PCOS) By some estimates, a woman diagnosed with PCOS — a hormone imbalance disorder — has a greater risk of developing type 2 diabetes than her peers without PCOS, according to a study published in August 2017 in the Journal of Clinical Endocrinology & Metabolism. (15) Insulin resistance and obesity are common denominators of these health conditions.

Being Over Age 45 The older you get, the more likely you are to develop type 2 diabetes, per the ADA. (16) But in recent years, an increasing number of children and teens have been diagnosed with prediabetes and type 2 diabetes.

Is Type 2 Diabetes Genetic?

Research on twins backs this up, according to an article published in December 2013 in the British Journal of Clinical Pharmacology. (17) Twins who are identical are more likely to both have diabetes compared with twins who are fraternal. And having a relative with diabetes may put you at a fourfold risk of developing the disease yourself.

Your ethnicity or race may affect your risk for type 2 diabetes, too, noted an article published in December 2013 in Current Diabetes Reports. (18) Data included in this paper suggests African Americans, Hispanic or Latino Americans, and certain Native American groups have a higher risk of type 2 diabetes than Caucasians.

How Is Type 2 Diabetes Diagnosed?

Receiving a prompt diagnosis is crucial for successfully treating type 2 diabetes. In a January 2019 paper in Diabetes Care, the ADA advised getting screened for the disease every three years if you’re age 45 or older and overweight. (19)

To screen you for type 2 diabetes, your doctor may administer one of the following tests, per the Mayo Clinic: (20)

Glycated Hemoglobin (A1C) Test A1C is a two- to three-month measurement of your average blood sugar levels. While an A1C of 5.7 or below is normal, anything between 5.7 and 6.4 percent signals prediabetes and a reading of 6.5 percent or higher on two different tests suggests you have diabetes.

Fasting Glucose Test This test involves giving a blood sample after you have fasted for eight hours, according to Medline Plus. (21) If you have a fasting blood sugar level of less than 100 milligrams per deciliter (mg/dL), your blood sugar levels are normal. But, the Mayo Clinic says, if you have one from 100 to 125 mg/dL, you have prediabetes, and if you have 126 mg/dL on two separate occasions, you have diabetes. (20)

A1C and fasting glucose are common tests used to diagnose diabetes, but if you’re pregnant or have a hemoglobin variant, your doctor may use another method, such as:

Oral glucose tolerance test

Random blood sugar test

Prognosis of Type 2 Diabetes

The prognosis of diabetes depends on several factors, including duration of disease, state of disease, and genetic factors. If you have had poorly controlled diabetes for a longer time, the greater your risk for complications such as heart disease and neuropathy, past research has noted. (22)

More on Type 2 Diabetes Prognosis

Don’t lose hope, though. You don’t have to be a statistic. Receiving a prompt diagnosis can help you get your health on track and reduce your risk for complications.

Indeed, if you take care to manage your blood sugar by following a healthy diet, exercising regularly, taking your prescribed medication, and losing weight, you may find your quality of life to be better with diabetes than it was before your diagnosis.

Insulin plays a large role in blood sugar stabilization. This visual guide shows what happens when your body doesn’t use this hormone properly.

Duration of Type 2 Diabetes

Although changes to your diet and lifestyle, and oral and injectable medication (such as insulin) can help manage type 2 diabetes, the disease's underlying predisposition for insulin resistance cannot be cured.

More on Exercising for Type 2 Diabetes

One way to bring blood sugar levels down is by losing 5 to 7 percent of your body weight. In the national Diabetes Prevention Program (DPP), participants who did just that and exercised for at least 150 minutes weekly cut their risk for type 2 diabetes by 58 percent, according to the CDC. (24) The Harvard T.H. Chan School of Public Health also notes that following a healthy diet, exercising regularly, and shedding extra pounds can improve your management of type 2 diabetes. (25)

With time, you may require additional treatments and, with poor blood sugar control, potentially insulin to better manage your blood sugar, according to Harvard. (25)

Hyperglycemia and Hypoglycemia

If you have type 2 diabetes, you’re at risk for high blood sugar and low blood sugar. Preventing these episodes requires knowing the signs, causes, and treatment options to get your blood sugar back in a healthy range.

Hyperglycemia (High Blood Sugar)

Between meals, the concentration of blood sugar for people without diabetes ranges from about 70 to 100 mg/dL. After meals it may reach 120 to 130 mg/dL but rarely goes higher than 140 mg/dL, according to an article in Diabetes Self-Management. (26)

But the Mayo Clinic notes that if you have type 2 diabetes, blood sugar levels can go much higher — to 200, 300, or even 400 mg/dL and beyond — and will go much higher unless you take the necessary steps to bring them down. (27)

Family members, coworkers, and other people you're in close contact with should be taught how to administer a glucagon injection in case you have a severe hypoglycemic event and can't do it yourself. According to the U.S. Food and Drug Administration (FDA), there are now also options for a prefilled syringe (Gvoke) and intranasal glucagon (Baqsimi). (32,33)

Treatment and Medication Options for Type 2 Diabetes

If you’ve been diagnosed with type 2 diabetes, you have various treatment options at your disposal.

Medication Options

For example, you may be prescribed the oral medication Glucophage (metformin), which can help lower your blood sugar levels.

While metformin is the first-line medication for individuals with type 2 diabetes, it’s not the only diabetes medication at your disposal.

Others include:

Sulfonylureas and Meglitinides This type of drug works by stimulating the pancreas to produce more insulin, according to Johns Hopkins Medicine. (34)

Alpha-Glucosidase Inhibitors These drugs can help slow digestion of certain carbs, to help prevent blood sugar spikes after you eat, noted an article published in November 2014 in Diabetes Self-Management. (35)

More on Affording Diabetes Meds

DPP-4 Inhibitors These drugs block the action of an enzyme called dipeptidyl peptidase-4 from preventing the body from breaking down GLP1, a hormone that increases insulin secretion in response to a glucose and slows glucose absorption from the gut, per Diabetes.co.uk. (38)

SGLT-2 Inhibitors These relatively new drugs facilitate the release of glucose through the urine by slowing the kidney's reabsorption of glucose, according to a review published in December 2014 in the journal Diabetes Therapy. (39)

While the Mayo Clinic notes that there aren't any alternative therapies proven to lower blood sugar or put type 2 diabetes in remission, some people have found success with a therapeutic keto diet, along with certain supplements. (4)

Consult your doctor if you're interested in one of these options, especially if you're on medication or insulin. (20)

Self-Care

Staying healthy with diabetes also requires caring for yourself — such as by protecting your feet, practicing oral hygiene, and tending to your mental health. According to an article published in June 2014 in Current Diabetes Reports, having diabetes doubles your risk for depression, and yet healthcare providers commonly miss this diagnosis in individuals. (40)

Insulin Options for Type 2 Diabetes

If you’re unable to control your blood sugar with oral or noninsulin injectable medication, diet, and lifestyle, you may need to add basal or bolus insulin to your treatment regimen.

Here's how they differ:

Basal InsulinThis type of insulin help control your blood sugar when you’re between meals or at night when you’re asleep, notes Johns Hopkins. (42)

Bolus Insulin This type of insulin is fast- or rapid-acting. You typically take it prior to a meal, according to Diabetes.co.uk. (43)

Bariatric Surgery and Type 2 Diabetes

Bariatric surgery is another treatment option if you’re managing type 2 diabetes, according to a review published in February 2019 in Diabetes Care. (44) Although it comes with some risks, per a past review, it may reverse type 2 diabetes in some individuals. (45)

Type 2 Diabetes Diet: What Can You Eat?

When you have diabetes, it’s important to avoid eating many packaged, processed snacks, such as cookies, chips, cake, granola bars, and the like, in lieu of fresh, whole foods, like fiber-rich fruits, veggies, and whole grains, according to the Mayo Clinic. (27) Eating foods high in fiber can help keep blood sugar levels steady and fill you up, potentially promoting weight loss and improving insulin sensitivity, according to a past meta-analysis. (46)

Monitoring your caloric intake may be helpful if you’re overweight, but everyone with type 2 diabetes should track how many carbs they’re taking in. That can be tricky because carbs are in many of the common foods you may already eat, but there are both good and bad sources of carbs. Fruits and vegetables, for example, are good sources, while pretzels and cookies are bad sources. (46) When you eat is just as important as what you eat when managing diabetes. Sticking to regular mealtimes can help keep your blood sugar steady, notes the Mayo Clinic. (27)

Also, know that being diagnosed with diabetes doesn’t mean you can’t eat the foods you love. A diabetes diet is essentially a healthy diet for everyone! You can work with a registered dietitian-nutritionist (RDN) to come up with a personalized meal plan, and be sure to track your blood sugar if you introduce new foods to your diet. (27)

While there’s no such thing as a “diabetes diet,” food choices can play a key role in your blood sugar control. (27)

If you’re interested in a specific diet plan, consider working with an RDN and certified diabetes educator (CDE) who can help you navigate the landscape. (27)

More on What People With Type 2 Diabetes Can Eat

Keto Diet for Type 2 Diabetes: Does It Work?

One of the most common ways people with type 2 diabetes attempt to lower their blood sugar is by drastically reducing their intake of carbs. The aforementioned September 2018 review in Endocrinology & Metabolism noted that carbohydrate counting is essential if you have diabetes, but extreme diets, like the ketogenic diet, which reduces carb intake to as little as 5 percent of your daily calories, can be risky for some people with diabetes. (4)

The ketogenic, or keto, diet calls for dramatically increasing your fat intake and consuming a moderate amount of protein and a very low amount of carbs, with the aim of kicking your body into a natural metabolic state called ketosis, in which it relies on burning fat rather than carbs for energy. Ketosis is different from diabetic ketoacidosis, a health emergency that occurs when insulin levels are low in conjunction with high levels of ketones, according to the Mayo Clinic. (49) Ketones are by-products of metabolism that are released in the blood when carb intake is low.

More on Low-Carb Diets for Type 2 Diabetes

While a past review suggested the ketogenic diet may result in quick weight loss and potentially even help put diabetes in remission, another study, published in April 2018 in Diabetes Therapy, pointed out that it’s important to work with your doctor to make sure your nutritional needs are being met. (50,51) Having this conversation is especially important if you’re on diabetes medication. While short-term studies have shown benefit to glycemic control, weight reduction, and medication reduction while on the keto diet, long-term data is still lacking. (51)

Some risks of the keto diet include low blood sugar, negative medication interactions, and nutrient deficiencies. People who should avoid the keto diet include those with kidney damage or disease, women who are pregnant or breastfeeding, and those with or at a heightened risk for heart disease due to high blood pressure, high cholesterol, or family history, according to a review published in February 2014 in the International Journal of Environmental Research and Public Health. (52)

Prevention of Type 2 Diabetes

There's no surefire way to prevent type 2 diabetes, but maintaining a healthy weight, following a healthy diet, and exercising regularly can help fend off the health condition. Reducing risk factors such as high cholesterol and high blood pressure can also play a role in type 2 diabetes prevention, notes John Muir Health. (13)

Complications of Type 2 Diabetes

If you have been diagnosed with type 2 diabetes, you may have anxiety or concerns about the prospect of future health complications, such as amputations, heart disease, and vision loss. But living with this disease doesn’t destine you for these unpleasant outcomes.

Preventing Type 2 Diabetes Complications

According to past research, long-term complications of type 2 diabetes can be prevented and, in some cases, reversed or slowed by a combination of: (53)

Blood sugar control

Blood pressure control

Blood cholesterol control

You should discuss your level of control (and how to maintain or improve it) with your doctor at every doctor’s appointment.

If you have been living with diabetes for several years or are older, knowing your A1C goal and levels is particularly important, because you are at a greater risk for developing type 2 diabetes complications, according to a past study. (54)

Health Problems Linked to Type 2 Diabetes

Cardiovascular Disease Compared with people without diabetes, people with diabetes are at a greater risk for heart disease, statistically get heart disease at a younger age, and have more severe forms of heart disease, according to the NHLBI. (55) The CDC points out that people with diabetes are also about twice as likely as people without diabetes to die of heart disease. (56)

Lowering your risk for heart disease — or treating it, if you have it — involves a combination of lifestyle changes and may or may not include medication, the CDC points out. (57)

Diabetic Retinopathy In diabetic retinopathy, high blood sugar weakens the capillaries (the tiny blood vessels) that supply the retina, the light-sensitive layer of tissue at the back of the inner eye.

The capillaries then swell, become blocked, or leak blood into the center of the eye, blurring vision. In advanced stages, abnormal new blood vessels grow.

When these new vessels leak blood, the result can be severe vision loss or blindness, according to the American Optometric Association. (58)

Diabetic Neuropathy Neuropathy, or nerve damage, can affect any nerve in your body. Most commonly, it affects the nerves in the feet, legs, hands, and arms; this condition is called peripheral neuropathy.

Peripheral neuropathy can cause tingling, burning, pain, or numbness in the affected areas.

The pain of peripheral neuropathy is difficult to control, though some find topical products that contain capsaicin to be helpful.

Prescription products that may help alleviate the pain caused by peripheral neuropathy include a variety of antidepressants and anticonvulsants, per the Mayo Clinic. (59)

More on Preventing Complications of Type 2

Diabetic Nephropathy (Kidney Disease) In diabetic nephropathy, the nephrons (or filtering units) in the kidneys become damaged from chronic high blood sugar.

High blood pressure compounds the problem, and high cholesterol appears to contribute to it as well.

In the early stages of diabetic nephropathy, you may not notice any symptoms, but standard blood and urine tests can detect early signs of dysfunction, and early treatment can stop or slow its progression.

As many as 25 percent of people with diabetes may develop kidney disease, according to the Mayo Clinic. (60)

Diabetic Ulcer People with diabetes have an increased risk of developing foot ulcers (open sores).

A diabetic ulcer is often painless, and people may not even know they have them at first.

These foot ulcers can take several weeks to heal, and are a primary reason for hospital stays among people with diabetes.

Research and Statistics: Who Has Type 2 Diabetes?

As mentioned, nearly 30.3 million people have diabetes, and the majority are living with type 2, according to CDC data. (1)

Worldwide, in 2014, the World Health Organization estimated that more than 422 million people had diabetes. (62)

Being overweight or having obesity are risk factors for type 2 diabetes, and so is ethnicity. For most groups of people, having a BMI of 25 or over is a risk factor for type 2 diabetes, but having a BMI of 23 or higher is a risk factor for Asian Americans, and having a BMI of 26 or greater is a risk for Pacific Islanders, according to the NIDDK. (7)

Related Conditions and Causes of Type 2 Diabetes

While the cause of type 2 diabetes is multifactorial, meaning there’s no single cause, certain conditions exist in conjunction with this condition.

According to the Cleveland Clinic, conditions related to type 2 diabetes include: (63)

Obesity

Heart disease

Peripheral vascular disease

Stroke

Neuropathy

Nephropathy

Retinopathy

Glaucoma

Cataracts

The good news is that tight blood sugar control, by way of diet, exercise, and medication, can prevent these comorbidities. (63) Getting support from peers can also help, potentially reducing hospitalization and rates of depression, according to a October 2018 study in Diabetes Care. (64)

Tips for Aging Well With Type 2 Diabetes

More on Building Your Diabetes Healthcare Team

Unfortunately, aging itself is a risk factor for type 2 diabetes, so the longer you live with diabetes, the more likely you’ll develop health complications, according to past research. (65)

Following tips like these can help you stay healthy and keep your blood sugar controlled: (65)

Lean on your medical team, which may consist of an endocrinologist, a podiatrist, an RDE and a CDE, and other specialty health professionals. In many cases, your primary care physician will be your main healthcare provider for diabetes care.

Stick to your medication regimen, and be open to potential medication adjustments.

Resources We Love

Favorite Orgs for Essential Diabetes Info

Everyday Health editors attend the AADE’s annual meeting to connect with certified diabetes educators, registered dietitians, and people like you, who are looking for ways to better manage blood sugar, diet, medication, and more. Check out information on this year’s meeting in Houston.

The ADA is considered the leading nonprofit for type 1 and type 2 diabetes education. The ADA's free yearlong program Living With Diabetes offers top-of-the-line resources for anyone new to living with diabetes. You’ll get access to their newsletter, expert Q&A session, and online support system, among other perks.

One of our favorite features from the AHA is a go-to resource for preventing heart disease: Know Diabetes by Heart. The ADA-supported initiative lays out a step-by-step guide for keeping your heart healthy while living with diabetes.

Favorite Alternative Medicine Resource

Want to give the ketogenic (“keto”) diet a whirl to better manage diabetes? This pioneering program from the Cleveland Clinic offers a way to do just that, with trained counselors who can help you adjust your diet and medication along the way.

More on Managing Type 2 Diabetes Naturally

Favorite Online Support Networks

Enter this website, and you’ll immediately feel less alone in your diabetes journey. They’ve got loads of inspiring patient stories in addition to their forum, which helps you connect with others managing diabetes.

These sisters truly have your back when it comes to using insulin at the dinner table, making your emotional health a priority, and all the other stuff you don’t know how to bring up with your diabetes care team. They rotate bloggers on a three- to six-month basis to share their diabetes journeys in their own words. And don’t let the site name fool you: “Diabetes Misters” are welcome too.

More on Finding Diabetes Peer Support

Favorite Site for Diabetes Products

The FOMO on diabetes products ends now. This feature by the magazine and website Diabetes Forecast rounds up the best of the best in CGMs (continuous glucose monitors), glucagon kits, insulin pens, and more.

More on Foods for Type 2 Diabetes

Favorite Resource for Becoming an Advocate

Want to get involved? The IDF, which reaches 168 countries, makes it easy with their advocacy network page. You’ll find different organizations that you can work with to help propel diabetes research, legislation, and awareness.

Favorite App

If you’re looking to home in on your A1C goal, this app’s for you. It lets you analyze dips and rises in your blood sugar, offers education about blood sugar management, allows you to work with a CDE virtually, and even links data from certain diabetes devices.

Favorite Retreat

Get away and give your diabetes management plan a makeover with this retreat option. Though pricey (at the lower end it's $3,500 per week), Pritikin offers an immersive experience with diabetes food classes, exercise education, and guidance from on-site experts.

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